State Balancing Incentive Payments Program (BIPP)

Forms and Documents

Document Name	Status
Form CMS-10411 State Balancing Incentive Payments Program (BIPP) Application Form and Instruction	Modified
Balancing Incentive Program_Supporting Statement - Part A [rev 11-29-11].DOC Supporting Statement A	2011-11-29

IC Document Collections

IC ID	Document Title	Status
199182	State Balancing Incentive Payments Program (BIPP) Application Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1145	ICR Reference No: 201111-0938-012
Status: Historical Active	Previous ICR Reference No: 201109-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: State Balancing Incentive Payments Program (BIPP)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/03/2012
	Date Received in OIRA: 11/30/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2015	36 Months From Approved	03/31/2012
Responses	56	0	56
Time Burden (Hours)	2,240	0	2,240
Cost Burden (Dollars)	0	0	0

---

Abstract: The Centers for Medicare & Medicaid Services work in partnership with States to implement Medicaid and the Children's Health Insurance Program (CHIP). Together, these programs provide health coverage for millions of Americans. Medicaid and CHIP are based in Federal statute, associated regulations and policy guidance, and the approvedState plan documents that serve as a contract between CMS and States about how Medicaid and CHIP will be operated in that State. When modifications or enhancements to the program are prescribed by Congress through legislation, each State's programs must be amended to comply. For example, in March 2010, Congress passed the Affordable Care Act, which enacted comprehensive reform of the Medicaid program. The Balancing Incentive Program was enacted as Section 10202 of that Act, and provides States an opportunity to balance their expenditures on long-term services and supports by incentivizing the increase of community versus institutional services.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 10202 Name of Law: Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 57746	09/16/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 73649	11/29/2011
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
State Balancing Incentive Payments Program (BIPP) Application	CMS-10411	State Balancing Incentive Payments Program (BIPP) Application

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	56	56	0	0	0	0
Annual Time Burden (Hours)	2,240	2,240	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/30/2011

---